HomeMy WebLinkAboutCI 22-97[1111P Totntltaumecatf4 of Maosadju ttii
CITY/TOWN OF YARMOUTH
In accordance with the Massachusetts State Building Code, Section 108.15, this
CERTIFICATE OF INSPECTION
is issued to .........................THOMAS. BS, KELLY .�.�IT,Cr .Ftie. M..................................
1 (gertlfg that I have inspected the....... SNACK. AAEt ...............known as..BASS. RIVER. =LF..COU.RSE
located at ....... HTGIL HANK. R04R ............... in the... TQVM..... of. ...... SOUY3. XAWQIJ.TH............. .
County of...BARNSTABLE..Commonwealth of Massachusetts. The means of egress are sufficient for the following
number of persons:
BY STORY
Story Capacity .. Story Capacity
Place of Assembly
or Structure
USE GROUP A-3
CLASS 5-B
#22
Certificate Number
Story Capacity Story Capacity
BY PLACE OF ASSEMBLY OR STRUCTURE
Place of Assembly
Capacity Location or Structure
'73 PERSONS' IST FLOOR
DatirC,,Ortificate Issued
FEBRUARY 18, 1998
Date Certificate Expires
Capacity Location
:
Building Official
The building official shaZZ be notified within (ZO) days of any changes in the above information.
PERIODIC INSPECTION REPORT
INSTRUCTIONS: THIS FORN IS TO BE COMPLETED EACH TIME A PERIODIC INSPECTION IS MADE. AT
THE TIME THAT A NEW CERTIFICATE IS ISSUED, A RECEIPT INDICATES THAT A FEE HAS BEEN PAID
WILL BE ATTACHED TO THIS FORM OR THIS FORM WILL BE STAMPED "PAID" PRIOR TO ISSUING THE
CERTIFICATE. ANY CHANGES SINCE THE LAST INSPECTION ARE TO BE ADDED TO THE FILE CARD OF
THE PREMISES. THIS SHOULD BE FILED BY STREET ADDRESS.
STREET AND NUMBER: HIGH BANK ROAD, SOUTH YARMOUTH, MA
NAME OF PREMISES: BASS RIVER GOLF COURSE
CERTIFICATE TO BE ISSUED TO: THOMAS B. KELLY/MICHAEL BEAN
ADDRESS:
OWNER OF RECORD OF BUILDING: TnWN c)F vARMOUTH
ADDRESS:
PURPOSE FOR WHICH PREMISES ARE USED: quAr•u anu
USE GROUP CLASSIFICATION OF PREMISES: A -
CHANGES SINCE LAST INSPECTION (REQUIRED ON FILE CARD):
1.
2.
3.
4.
5.
DATE: ORDER ISSUED:
ORDER ISSUED TO:
ADDRESS:
DATE VIOLATION (S) CORRECTED:
I HAVE THIS DAY INSPECTED THE ABOVE DESCRIBED PREMISES, AND THE SAME CONFORMS TO THE PERTINENT
REQUIREMENTS OF THE MASSACHUSETTS STATE BUILDING CODE AND THE RULES AND REGULATIONS
PURSUANT THERETO.
DATE
CERTIFICATE NUMBER: #22
DATE ISSUED:
DATE EXPIRES: FEBRUARY 18, 1998
RECOMMENDED NEXT INSPECTION DATE:
BUILDING OFFICIAL
COMMONWEALTH OF MASSACHUSETTS 3 -�, 5�-` le -2 6
City/Town of YARMOUTH
APPLICATION FOR
ERTIFICATE EXPIRES
Date JANTTARY 97 _ 1997
FEB 1, 21997
OF INSPECTION
PAYABLE UPON RECEIPT
(Xy) Fee Required $ 40.00
( ) NO Fee Required
In accordance with the provisions of the Massachusetts State
Building Code, Sec. 108,15, I hereby apply for a Certificate of
Inspection for the below -named premises located at the following
address:
Street and Number 62 HIGHBANK ROAD, SOUTH YARMOUTH, MA 02664
Name of PremisesBASS RIVER GQTZ! =12gE SM21CK RAR TFT.
-
Purpose for which premises is used SNACK BAR
License (s) or Permits (s) required for the presises by other govermental
Agencies:
License or Permit Agency
Certificate to be issued to TFT."
Address:
Owner of Record of Building =o4ll of i�N1t�*tdU"7�
Address Ga 7`J1/6ffM41e PVb
Present Holder of Certificate-77f&'tI
(�_-? 1,6 &Iga
Signature of Person to w1iom Certifi-
cate is issued or his agent
2 //Y % //GH11e_4 _ffC5 9k�
Instructions: :take Check Payable to Town of Yarmouth
492te�
--o
Title,
D
ate
1146 Route 28 S. Yarmouth, Ma 02664
Return this application to BUILDING INSPECTORS OFFICE
Please note:
Application form with accompaning fee must be submitted for each building or
structure or part thereof to be certified.
Application and fee must be received before the certificate will be ussued.
The building offical shall be notified within ten (10) days ofany change in
the above information. PLEASE SEND US A COPY OF YOUR
n
aj Q �J WORKER'S COMPENSATION INSURANCE
Certificate r! / / FORM WITH THIS APPLICATION OR WE CANNOT
ISSUE YOUR CERTIFICATE OF INSPECTION.